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Stoma

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This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.

Published in: Health & Medicine
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Stoma

  1. 1. Stoma / Ostomy K. Kavindya M. Fernando JMJ 1
  2. 2. Contents • What is an ostomy • Types of ostomy • Attachment of stoma appliance • Ileostomy vs colostomy • Loop ileostomy (total procto-colostomy) • Double baral stoma • Complications • Diet • Colostomy irrigation JMJ 2
  3. 3. What is an ostomy? • An opening, • In the small intestine or large intestine, • Created as an outlet through the anterior abdominal wall, • In order to pass fecal matter into a bag • STOMA = part of intestine we use to create this outlet JMJ 3
  4. 4. Purpose of stoma • It reduces pain and discomfort • Allows systematic defication • May help relieve symptoms of intestinal disease JMJ 4
  5. 5. Disease conditions where you might need stoma • Inflammatory bowel disease • Ulcers • Polyps • Cancers • Disorders of bowel function – Hurschprung’s disease • Accidental injury • Congenital deformities of anus and rectum JMJ 5
  6. 6. Type of ostomy Ostomy Ileostomy Colostomy JMJ 6 Stoma of the terminal part of small intestine An artificial opening made in the large bowel to divert feceas and flatus to external environment, where it can be collected into an external appliance
  7. 7. JMJ 7
  8. 8. Type of ostomy Stoma Temporary Permanent JMJ 8 Stoma of the terminal part of small intestine An artificial opening made in the large bowel to divert feceas and flatus to external environment, where it can be collected into an external appliance
  9. 9. Attachment of the stoma appliance JMJ 9
  10. 10. Attachment of the stoma appliance JMJ 10
  11. 11. Attachment of the stoma appliance JMJ 11 1. Remove the colostomy bag carefully
  12. 12. Attachment of the stoma appliance JMJ 12 2. Check the stoma for the colour If it is black- consult your doctor Stoma has to be pink, red in colour Clean the stoma well Let it dry
  13. 13. Attachment of the stoma appliance JMJ 13 3. Try using a skin barrier, such as stoma powder. Sprinkle stoma powder around the stoma. Be careful not to put the powder on the stoma itself. Carefully dust it around using a dry wipe, and let the area dry for about 60 seconds.
  14. 14. Attachment of the stoma appliance JMJ 14 4. Place the transparent stoma template over your stoma, to assess the diameter Opening should match the diameter – skin irritation
  15. 15. Attachment of the stoma appliance JMJ 15
  16. 16. Attachment of the stoma appliance JMJ 16 5. Remove the sticker of the wafer and fix it carefully
  17. 17. Attachment of the stoma appliance JMJ 17 6. Fix the pouch to the wafer Clip the other end Apply micropore plasters around the wafer Wafer may be left in place for 7 days
  18. 18. Colostomy vs ileostomy JMJ 18
  19. 19. Colostomy vs ileostomy Ileostomy Colostomy Sprout + No sprout / flush Site Usually in RIF Temporary colostomy – transvers or right upper quadrant End colostomy – usually in LIF Effulent Liquid contain some amount of enzymes (alkali and proteolytic enzymes)  excoriation of skin + (Autodigestion) Solid, hard stools compaired to ileostomy Watery liquid stools Hard stools Oddor Oddor + Oddor is more Frequency of discharge Higher Lower Circular folds on the ileum + no More likely to develop fluid and electrolyte problems JMJ 19
  20. 20. Total procto-colectomy JMJ 20
  21. 21. Indications • Familial adenomatous polyposis • Size >1cm • Amount >100 polyps • Microscopy of polyp – villous & tubovillous (less harmful) • Ulcerative colitis – not responded to medication • Ulcerative colitis with dysplasia • UC with perforations JMJ 21
  22. 22. Indications JMJ 22 Contents are liquid Create a pouch to storage function Artificial pouch
  23. 23. Artificial pouch JMJ 23 • After anastomosis you have to rest the anastomosis site • To prevent that – make a loop ileostomy in the RIF to divert feces • Can reverse after 6/52 when the anastomosis is healed
  24. 24. Loop ileostomy JMJ 24
  25. 25. Loop ileostomy JMJ 25
  26. 26. Mucous fistula / Double barrel stoma JMJ 26
  27. 27. Double barrel stoma • Bowel is surgically severed and 2 ends are brought out into the abdomen as 2 separate stomas • Proximal end – functional stoma • Distal end – non functioning (mucus fistula) • Used in temporary diversion – cases where resection is required due to perforation or necrosis JMJ 27
  28. 28. Complications of stoma JMJ 28
  29. 29. Complications Complications Early Late JMJ 29 1. Ischemia 2. Bleeding 3. Retraction 4. Skin excoriation 1. Prolapse 2. Peristromal hernia 3. Recurrent disease 4. Bowel obstruction
  30. 30. Ischemia • Due to impaired blood flow • Poor blood supply when stoma is formed • Too tight stoma bag • Too tight dresses over storma • Management • Close observation during post op period • A clear plastic appliance should be fitted • Avoid tight clothing • Inform your surgeon if you notice any colour change JMJ 30
  31. 31. Bleeding • Overenthusuastic cleaning • When using template for measurement • Bleeding from lumen is more serious • Portal HPT in cirrhosis • Recurrence of colonic CA • Management • Do not rub your stoma • Be careful when applying the bag • Compress with guaze • Usually resolve without interventions JMJ 31
  32. 32. Retraction • Recession of the stoma • away from the skin surface • due to excess tension of the stoma • Insufficiant fixation • Post op weight gain • Management • Use and appliance with rigid flange • Apply stoma adhesive paste before fixing appliance JMJ 32
  33. 33. Herniation vs prolapse Herniation Stoma prolapse JMJ 33
  34. 34. Excoriation of skin • Make sure the wafer and the pouch are well fixed • Control excessive mucus discharge • Be cautious of the size of the stoma and the wafer • Use luke warm water and mild soap to clean the peristomal skin • Never use alcohol agents, savlon, creams, powder or chemical agents to clean • Never use artificial drying methods. Ex: hair driers JMJ 34
  35. 35. Excoriation of skin • Management • Educate the patient about appliance change • Consider a 2 piece appliance to allow healing • Use stoma adhesive powder or pase • Do not use antiseptics for cleaning peristomal skin • Change the base plate as soon as it leaks • A methyl cellulose skin wafer is helpful JMJ 35
  36. 36. Excoriation of skin JMJ 36
  37. 37. Ostomy and your diet JMJ 37
  38. 38. Avoid • Vegetables – raddish, cabbage, garlic, cucumber, kno-kol • Are known to result in offensive odour • Carbanoted beverages, chewing gum and smokinh • Causes excess gas in stoma appliance • High and moderate fiber diet JMJ 38
  39. 39. Low fiber diet (0-10%) JMJ 39 Vegetables 1. Beans 2. Carrot 3. Onion 4. Chillies 5. Tomato 6. Cabbage 7. Kankun Fruits 1. Orange 2. Dates (dried) 3. Passion fruit Animal products 1. Eggs 2. Prawns 3. Milk 4. Cheese 5. Butter Pulses 1. Green gram 2. Dhal 3. Soya bean 4. Cowpee Cereal 1. Barley 2. Maize 3. Kurakkan 4. Rice (raw- white) 5. Rice (parboiled- white)
  40. 40. Advices • Chew your food well and consume adequate amounts of water JMJ 40
  41. 41. Colostomy irrigation JMJ 41
  42. 42. Colostomy irrigation • Normally done in patients with a • Permement colostomy • Who need bowel preparation for special investigations –colonoscopy • Usually done it after 1 year of stoma creation • Takes about 45 minutes JMJ 42
  43. 43. Contraindications • Ileostomy • Ascending colon stoma • Transverse colon stoma JMJ 43
  44. 44. Requirement for stoma irrigation • 1.5 – 2 L of luke warm water • Resovior bag • A tube with a controller and a funnel shaped introducer, which prevents damage to stoma • 2 clips to close the bag • Bag to discard feces JMJ 44
  45. 45. Requirement for stoma irrigation JMJ 45
  46. 46. Requirement for stoma irrigation JMJ 46
  47. 47. Thank You! JMJ 47

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